Postoperative hernia or post incisional hernia, or eventration, occurs after surgery in a failure of proper healing of abdominal wall. Over time, this abdominal wall defect will increase progressively sometimes reaching gigantic size with whole organs almost completely leaving the abdominal cavity into the hernia sack. These are posing a lot of surgical problems due to the fact that increasing intra-abdominal pressure after relocating the organs back into the abdominal cavity, the intra-abdominal pressure rises and the respiratory system is under intense stress. These patients often require preoperative maneuvers designed specifically to compensate for postoperative respiratory function.
Another aspect of this pathology is the presence of scar formations called granulomas, an abnormal reaction triggered by suture materials, in the initial plague, usually these are discovered only during surgery. These require special precautions in order to extract them if possible without contamination of the wound, which helps healing without complications.
Diagnosis is often clinical, but a complete preoperative balance is necessary to fully assess the health status and correct appreciation of the conditions under which intervention should take place and what type of intervention the patient needs. If possible an examination of abdominal computed tomography can provide important clues on the exact dimensions of the parietal defect as well as the state organs located in the bags, often multiple, of hernia. In addition, you can appreciate the condition allowing abdominal organs preoperative detection of any abnormalities that can be solved in the same time.
The only recommended treatment is surgical, with the condition that the patient must meet the requirements necessary to perform the surgical act.
The solution adopted in the present is to use synthetic materials for prosthetic parietal defects. Approach may be the classic, incisional, or laparoscopic, with minimal incisions, using video monitoring through a mini camera that provides images on a monitor in the operating room. Laparoscopic techniques require careful assessment not only of the hernia but also of the general patient condition. Laparoscopic techniques require general anesthesia with intubation to achieve a complete relaxation of the abdominal muscles to create room to work inside. General anesthesia requires hospitalization for a day or tow to monitor patients, as opposed to local anesthesia or loco-regional anesthesia that allow patients to leave the clinic the same day.
After surgery the patient will resume normal activity and sport gradually, using various types of external support to allow for the perfect wound healing.
Postincisional hernias are responsible for multiple major disease complications and permanent changes affecting the lives of patients, so resolving these pathology should be a priority.
Eduard Ursuleanu, General Surgeon, ProEstetica Medical Center